Healthcare Provider Details

I. General information

NPI: 1689768855
Provider Name (Legal Business Name): WESTSIDE REHAB, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/03/2006
Last Update Date: 10/28/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

126 S. MAIN
LAURIE MO
65038-1099
US

IV. Provider business mailing address

P.O. BOX 1099
LAURIE MO
65038-1099
US

V. Phone/Fax

Practice location:
  • Phone: 573-374-7579
  • Fax: 573-374-1399
Mailing address:
  • Phone: 573-374-7579
  • Fax: 573-374-1399

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code261QP2000X
TaxonomyPhysical Therapy Clinic/Center
License Number
License Number StateMO
# 2
Primary TaxonomyY
Taxonomy Code261QP2000X
TaxonomyPhysical Therapy Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: MRS. TENESSA JEAN REHMER
Title or Position: PRACTICE MANAGER/VP/SECRETARY
Credential:
Phone: 573-374-7579